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頁籤選單縮合
| 題 名 | Extrapleural Malposition of Chest Tube in Pneumothorax Patient with Pulmonary Tuberculosis: Report of a Case=肺結核氣胸胸管胸膜外誤置:病例報告 |
|---|---|
| 作 者 | 林杏麟; 李維哲; 陳昭文; 郭良基; 石明誠; | 書刊名 | 臺灣外科醫學會雜誌 |
| 卷 期 | 41:6 2008.11-12[民97.11-12] |
| 頁 次 | 頁297-300 |
| 分類號 | 415.434 |
| 關鍵詞 | 肺結核; 氣胸; 氣血胸; 胸管; Pneumothorax; Hemothorax; Malposition; Chest tube; Pulmonary tuberculosis; |
| 語 文 | 英文(English) |
| 中文摘要 | 氣血胸的病人主要以插入胸管來治療,但有時胸管會被放置到不正確的位置。如此一來,不僅原本的問題沒有解決,反而有可能會造成病人更嚴重的問題及引起更可怕的災難。我們報告一位因肺結核以藥物治療三個月的病人,伴隨發生氣胸造成病人呼吸喘。到急診照胸部X光後緊急插入胸管。很不幸的,因爲肺結核造成病人肋膜增厚,使醫師在插胸管時以手指探查中誤以爲增厚的肋膜就是肺組織,造成胸管沒有被置入到正確的位置而插入到胸膜外側。在做完胸部電腦斷層後,胸管被重新插入。由於很難藉由胸部X光正確判斷胸膜外側胸管的位置,此誤置的胸管被延遲診斷。由於胸管胸膜外置放是非常少見,而且很難在胸部X光下診斷,所以要正確的診斷,不能只靠胸部X光。一般在急診只能用胸部電腦斷層診斷去確定胸管的位置。所以,對於有肺結核,並引發氣胸而需要插胸管的病人若引流的效果不理想,即使胸部X光影像顯示的位置看來似乎正確,醫師仍應該要注意並確定胸管的位置是否正確。此時,不管胸管的位置、功用看起來是否正常,應儘早以電腦斷層重新評估。若發現錯誤,應立即重新置入胸管。此事於慢性肺部疾病的病患特別重要。 |
| 英文摘要 | Treatment of patients with pneumothorax and hemothorax is mainly by insertion of a chest tube. However, if the chest tube is not inserted into the proper position, not only will the treatment be unsuccessful, but adverse? consequences may occur which jeopardize the patient. We herein report a patient who had pulmonary tuberculosis treated for three months by anti-tuberculosis drugs, but subsequently developed progressive dyspnea. He was sent to the emergency department and a chest tube was inserted because of diagnosis of pneumothorax by chest radiography. The infection of pulmonary tuberculosis caused pulmonary fibrosis with thickening of the pleura which misled the physician to believe the thickened pleura to be the lung, while using his finger to dissect and enter the pleural space. This chest tube was inserted into the extrapleural space and not into the pleural space. Recognition of the mistake was delayed because of the rare incidience of extrapleural insertion and the difficulty in diagnosis by plain chest radiography. Chest computed tomography (CT) detacted the mistake and confirmed that the chest tube needed re-insertion. Therefore, in patients having pneumothorax with pulmonary tuberculosis after insertion of a chest tube, even if the chest radiograph seems to show normal position of the chest tube, early reevaluation of its position by a CT scan should be performed at once, whenever the chest tube does not function normally, especially in patients with chronic pulmonary disease. |
本系統中英文摘要資訊取自各篇刊載內容。